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Psychiatrist Shares On How To Deal With Postpartum Depression

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Giving birth to a child can be considered one of the most memorable life events for any mother. Many women have said that it is one of the most joyful occurrences in their lifetime, bringing life into this world. A child can be the manifestation of all their hopes and dreams for the future as well as their partners’. They have usually spent months reading about pregnancy, childbirth as well as “the best” technique to raise a child.

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Therefore, it becomes jarring for some new mothers who feel depressed or feel a void after childbirth.

They had come to expect a sense of joy or fulfillment afterwards and are disappointed when this does not happen. Some women might even feel depressed before childbirth, during pregnancy, and they feel anxious wondering why they are not excited about the baby and feel something is wrong with them, thinking that they do not love their baby enough, and feel depressed all over again with this negative thought.

It is unfortunate that postpartum depression occurs, and that it affects about 10% of women.

This could occur even up to 1 year after delivery as well as during pregnancy. Over 90% of women who develop postpartum depression would start experiencing symptoms within the first 4 months after childbirth.

How do we differentiate “postpartum blues” with “postpartum depression”?

The most common question I get from patients is “Do I really have postpartum depression? I’m sure all mothers feel a little down since we’re all so tired anyway.

Postpartum Blues

Postpartum blues refers to when a new mother experiences mood lability – such as sadness/crying spells, getting more irritable, and even sometimes decreased concentration.

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It is indeed true that mood is a spectrum and when any human being goes through the hormonal roller coaster of a ride called pregnancy and childbirth, with the added extra work of planning for the arrival or having to care for a baby, emotions can get a little out of control.

About 50% of women will likely feel postpartum blues even within the week of giving birth.

There’s a biological reason for that feeling.

Women who have given birth will have a sudden drop in estrogen levels since we no longer need as much to protect the pregnancy, which in turn increases an enzyme in the brain called “Monoamine oxidase A” that will cause the breakdown of hormones that control and are good for mood.

Postpartum Depression

We define postpartum depression when the symptoms of depression are “pathological” meaning that it has affected our health. What does that mean?

Instead of just feeling these symptoms, it is causing a disruption in our everyday life and activities,

  • When we lose our appetite and are not eating as much as we need
  • When we develop insomnia, and are not able to sleep (not able to sleep when our newborn is sleeping)
  • A loss of interest in activities we use to enjoy, or a loss of interest in the baby
  • A loss of energy, feeling fatigued all day even when we have just woken up after sufficient sleep
  • When we experience feelings of worthlessness or even excessive guilt (that a “normal” person would not feel guilty about – typically new mothers would keep insisting that they are a bad mother even though this is not the case)
  • Inability to concentrate or think
  • If severe, thoughts of dying, suicide or even infanticide (thoughts of hurting the baby) occur

Do I really need to seek help?

This is the second most common question from my patients. About half of patients will recover from depression without any treatment within 1 year.

However, when we look at the consequences of untreated depression especially postpartum depression, I think we need to seriously consider seeking help.

This is because:

  1. Mothers who are depressed are less likely to breastfeed
  2. Mothers who are depressed are less likely to bond well with the infant
  3. Abnormal physical and cognitive development in the child
  4. It usually causes a strain in the marriage
  5. Risk of suicide/infanticide
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How do I recognize postpartum depression in my wife/family member?

Most of the symptoms that we have discussed are very subjective and is something that is felt by the mother. But there are some signs that we can look for as a “red flag” that we need to step in and help new mothers seek help.

As we have discussed above, mood is a spectrum, and the red flags are typically when mothers are at either end of the spectrum.

We should be concerned when:

  1. A mother is extremely anxious about the newborn, unable to be reassured by family members or doctors, repeatedly bringing or trying to bring the infant to a clinic/hospital. She would feel very anxious about her own ability to care for the newborn, getting angry easily or seemingly thinking any crying/behavior displayed is directed towards her, and part of judging her care for the baby.
  2. On the other hand, a mother could be depressed and lose all interest in the baby, seemingly as if she did not just give birth to a child, would not go for any follow ups that are required for the baby or herself. She might be despondent and would not respond when the baby is crying.

The situations above does not automatically mean postpartum depression, but if you or your loved one is experiencing this, I would be very concerned and would seek help from a mental health professional.

Dr. Aw Tsung Wai
Dr. Aw Tsung Wai

Dr Aw is a Yale and Jefferson (USA) trained Consultation-Liaison/Psychosomatic Medicine Psychiatrist, currently practicing telepsychiatry, with a love for travelling and an eventual goal of being able to scratch off all the countries on his scratch-off world map.

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